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Obesity Overview The World Health Organization, (WHO) has identified Obesity as one of the greatest public health challenges of the 21st century. Overweight and obesity are now linked to more deaths worldwide than underweight.. Obesity is fast becoming the a leading health concern in the US, with the following statistics 39.8 % of adults > 20 years of age with Obesity 70.7 % of adults with Overweight and Obesity Obesity Rises Healthcare Cost Rises Obesity significantly increases a person’s risk of developing numerous non-communicable diseases, including cardiovascular disease, cancer, diabetes, sleep disturbance, and other disabilities. The risk of developing more than one of these diseases also increases with excess body weight. Why Obesity IS a disease • It is associated with impaired body function • Like other diseases, it results from physiological dysfunction • Though frequently precipated by environmental forces in modern society, the final common pathway of obesity reflects abnormal physi- ology • It causes, exacerbates or accelerated more than 225 comorbid diseases • It is associated with a substantial burden of morbidity and premature death
Metabolic 225+ Structural Inflammatory Comorbidities Degenerative afgecting EVERY organ system and Neoplastic medical speciality Physiological It is evident from multiple population studies that obesity, that an increase in adipose tissue or excess fat- leads to dysfunctional fat tissue resulting in hormonal (endocrine) and immune dysfunction- called Adiposipathy or SICK FAT DISEASE . It also results in pathogenic physical forces from excess body fat causing stress and damage to other body tissues, called Adiposity or Fat Mass Disease . As the obesity epidemic soars, it is important to note that most doctors do not have the clinical training to appropriately treat it. It is imperative to seek out a physician specifically trained in Obesity Medicine and certified by the American Board of Obesity Medicine, which is a specialty dedicated to the comprehensive care of patients with overweight and obesity.
Classification of Obesity Obesity can be classified into three stages I, II, and III. This Classification is determined by a combination of BMI( Body Mass Index) Body Fat Percentage, and Waist Circumference. BMI The following BMI chart is measured in kilograms per meters squared (kg/m 2 ) NORMAL OVER- CLASS I CLASS II CLASS WEIGHT WEIGHT OBESITY OBESITY III OBE- SITY 18.5-24.9 25.0-29.9 30.0-34.9 35.0-39.9 ≥ 40 Exceptions and Ethnic Variations for BMI Difgerent BMI cutofg points are more appropriate based upon ethnicity ETHNICITY/ OVERWEIGHT OBESITY GEOGRAPHY >27-29 CHINA 23-24 >29 JAPAN >24 INDIA >23 >27 SINGAPORE >22 >27 LATIN AMERICA, >23 >27 CENTRAL & SOUTH AMERICAN Body Fat Perentage Men >25 % Body Fat is Considered Obese Women > 32 % Body Fat is Considered Obese ESSENTIAL FAT ATHLETES FITNESS ACCEPTABLE OBESITY Women: Women: Women: Women: Women: 10-13% 14-20% 21-24% ≥ 32% 25-31% Men:2-5% Men: 6-13% Men: 14- Men: Men: 18- 17% ≥ 25% 24%
Waist Circumference/ Abdominal Obesity Men ≥ 40 Inches or 102 Centimeters Women ≥ 35 Inches or 88 Centimeters Abdominal Obesity cutofg points also vary based upon ethnicity Abdominal Obesity in Abdominal Obesity Men in Women USA/Canada/Europe USA/Canada/Europe ≥ 40 inches or 102 cm ≥ 35 inches or 88 cm Middle East/Mediterranean Middle East/Mediterranean Sub-Saharan Africa Sub-Saharan Africa ≥ 37 inches or 94 cm ≥ 31.5 inches or 80 cm South Asians, Chinese, Japa- South Asians, Chinese, nese Japanese South & Central American South & Central American ≥ 35 inches or 90 cm ≥ 31.5inches or 80 cm Waist to Hip Ratio (WHR) Men >1.1 Women >0.8 Obesity Is Obesity is Not A disease Your fault • • • A worldwide health • Yours to manage alone concern • Just about food • Caused by many factors • Cured by a miracle • Treatable and manageable treatment The causes of obesity are much more than simply overeating. It is a common misconception that obesity is due to lack of willpower or self-motivation. It is a chronic disease that needs to be prevented and managed, often requiring lifelong treatment. The causes of obesity are widespread and multifactorial.
Obesity can be caused by any one or a combination of the factors listed below: Neuro- behavioral Social & Hormonal Cultural Environm- Immune ental OBESITY Genetic/Epi- Medications genetic Genetic Obesity and Increased Risk of Chronic Metabolic Conditions. Type II Diabities Dyslipi- Heart demia Disease Hyper- tension Reprodu- OBESITY ctive disorders Sleep Apnea Joint Liver Disease Disease (NAFLD) Cancer Risk
Health Benefits of Treating Obesity Even a moderate amount of weight loss can have significant health benefits. CONDITION AMOUNT OF WEIGHT LOSS NEEDED TO EFFECT IMPROVEMENT 5-15% weight loss associ- ated with lower A1C and TYPE 2 DIABETES reduce number and doses of medications PREDIABETES & METABOLIC 10% weight loss to prevent SYNDROME type 2 Diabetes DYSLIPIDEMIA HYPERTENSION 5-15% lowers systolic and diastolic blood pressure, reduces number and doses of antihypertensive medi- cation OBSTRUCTIVE SLEEP APNEA 10% weight loss required for significant improvement KNEE PAIN AND FUNCTION 5-10% improves knee func- tionality, speed of walking NON-ALCOHOLIC FATTY 10-15% required for signifi- LIVER DISEASE cant improvement ASTHMA 7-8% required for signifi- cant improvement PCOS 5% weight loss improves ovulatory cycles and sub- sequent pregnancy MOBILITY, MORTALITY, 5-15% may show significant QUALITY OF LIFE, DEPRES- improvement SION, URINARY INCONTI- NENCE SEXUAL FUNCTION
Health Benefits of Treating Obesity Even a moderate amount of weight loss can have significant health benefits. Treatment of Obesity as a Chronic Metabolic Disease • Treat Obesity as any other disease • Approach in a confident, supportive ad non-judgemental way • Listen and Hear what the patient is telling • Pursue a step-wise strategy while exploring combinations as needed • A comprehensive treatment approach with compassion is paramount SRINIVAS C KOTA MD FMNM DIPLOMATE, AMERICAN BOARD OF OBESITY MEDICINE DIPLOMATE, AMERICAN BOARD OF INTERNAL MEDICINE DIPLOMATE, AMERICAN BOARD OF METABOLIC AND NUTRITIONAL MEDICINE
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